中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2009年
6期
474-477
,共4页
胃肿瘤%淋巴结转移%浆膜%胃切除术
胃腫瘤%淋巴結轉移%漿膜%胃切除術
위종류%림파결전이%장막%위절제술
Stomach neoplasms%Lymph node metastasis%Serous membrane%Gastrectomy
目的 分析不同浆膜反应类型胃癌淋巴结转移的特点,探讨其对实施合理根治术的指导意义.方法 收集73例因胃癌行全胃切除术患者的临床病理资料,按照浆膜反应类型分为正常型和反应型、结节型、腱状型和多彩弥漫型3组.比较3组间的淋巴结转移情况.结果 73例患者中,有61例出现淋巴结转移,转移率为83.6%.全组共切除2137枚淋巴结,其中有癌转移的淋巴结762枚,转移度为35.7%.正常型和反应型转移度为5.3%,结节型转移度为37.1%,腱状型和多彩弥漫型转移度为50.0%,差异有统计学意义(P<0.01).按照淋巴结分组分层,绝大多数淋巴结分组中不同浆膜反应类型患者淋巴结转移率差异也有统计学意义(P<0.01).结论 在胃癌浆膜分型中,正常型和反应型淋巴结转移度最低,结节型居中,腱状型和多彩弥漫型转移度最高.行胃癌切除术时,可根据浆膜反应类型判断淋巴结的转移程度,选择合理的术式.
目的 分析不同漿膜反應類型胃癌淋巴結轉移的特點,探討其對實施閤理根治術的指導意義.方法 收集73例因胃癌行全胃切除術患者的臨床病理資料,按照漿膜反應類型分為正常型和反應型、結節型、腱狀型和多綵瀰漫型3組.比較3組間的淋巴結轉移情況.結果 73例患者中,有61例齣現淋巴結轉移,轉移率為83.6%.全組共切除2137枚淋巴結,其中有癌轉移的淋巴結762枚,轉移度為35.7%.正常型和反應型轉移度為5.3%,結節型轉移度為37.1%,腱狀型和多綵瀰漫型轉移度為50.0%,差異有統計學意義(P<0.01).按照淋巴結分組分層,絕大多數淋巴結分組中不同漿膜反應類型患者淋巴結轉移率差異也有統計學意義(P<0.01).結論 在胃癌漿膜分型中,正常型和反應型淋巴結轉移度最低,結節型居中,腱狀型和多綵瀰漫型轉移度最高.行胃癌切除術時,可根據漿膜反應類型判斷淋巴結的轉移程度,選擇閤理的術式.
목적 분석불동장막반응류형위암림파결전이적특점,탐토기대실시합리근치술적지도의의.방법 수집73례인위암행전위절제술환자적림상병리자료,안조장막반응류형분위정상형화반응형、결절형、건상형화다채미만형3조.비교3조간적림파결전이정황.결과 73례환자중,유61례출현림파결전이,전이솔위83.6%.전조공절제2137매림파결,기중유암전이적림파결762매,전이도위35.7%.정상형화반응형전이도위5.3%,결절형전이도위37.1%,건상형화다채미만형전이도위50.0%,차이유통계학의의(P<0.01).안조림파결분조분층,절대다수림파결분조중불동장막반응류형환자림파결전이솔차이야유통계학의의(P<0.01).결론 재위암장막분형중,정상형화반응형림파결전이도최저,결절형거중,건상형화다채미만형전이도최고.행위암절제술시,가근거장막반응류형판단림파결적전이정도,선택합리적술식.
Objective To evaluate the relationship between serosal invasion types and lymph node metastasis after total gastrectomy in gastric cancer patients, and explore its significance in planning practice rational dissection based on the serosa types of gastric cancer during surgery. Methods A total of 73 gastric cancer patients ,who underwent total gastrectomy and lymph node dissection ,were included in this study, and their clinicopathological data were analyzed. The serosa of gastric cancer was divided into five types: normal, reactive, nodular, tendonoid, and color-diffused, then they were combined into 3 groups: group 1: normal and reactive, group 2: nodular ( including protruding nodular and flat nodular), and group 3: tendonoid and color-diffused. The lymph node metastasis ratios in the 3 groups were compared. The lymph nodes in each of the 3 groups were divided into 16 subgroups and the lymph node metastasis ratios of each subgroup in the 3 groups were compared and analyzed. Results The lymph node metastasis ratio of the gastric cancer with normal and reactive type serosa was 5.3% (26/492), the nodular was 37.1% (250/ 673), the tendonoid and color-diffused was 50.0% (486/972). The lymph node metastasis ratio of normal and reactive type groups was the lowest, that of the tendonoid and color-diffused groups was the highest, and the nodular type in between, showing a statistically significant difference (P < 0.01 ). The results of comparing the lymph node metastasis ratios from the 1 st to 16th subgroup in the 3 groups showed the same trend ( P < 0.05). Conclusion Among all serosa types of gastric cancer, the lymph node metastasis ratio of the tendonoid and color-diffused is the highest, the normal and reactive type is the lowest, and the nodular in between. The extent of rational dissection should be carried out on the basis of serosa types of gastric cancer during surgery. An extended dissection including D2 and D3 lymphadenectomy should be performed for the patients with tendonoid and color-diffused serosa, a rational decreased operation including D1 ～ D1 <'+> lymphadenectomy should be performed for those with a normal and reactive type serosa, and for the patients with nodular type serosa, we suggest performing standard D2 dissection.
